pubmed.ncbi.nlm.nih.gov

Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era - PubMed

Comparative Study

Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era

Lise E Nigrovic et al. Pediatrics. 2002 Oct.

Abstract

Context: Children with meningitis are routinely admitted to the hospital and administered broad-spectrum antibiotics pending culture results because distinguishing bacterial meningitis from aseptic meningitis is often difficult.

Objective: To develop and validate a simple multivariable model to distinguish bacterial meningitis from aseptic meningitis in children using objective parameters available at the time of patient presentation.

Design: Retrospective cohort study of all children with meningitis admitted to 1 urban children's hospital from July 1992 through June 2000, randomly divided into derivation (66%) and validation sets (34%).

Patients: Six hundred ninety-six previously healthy children aged 29 days to 19 years, of whom 125 (18%) had bacterial meningitis and 571 (82%) had aseptic meningitis.

Intervention: Multivariable logistic regression and recursive partitioning analyses identified the following predictors of bacterial meningitis from the derivation set: Gram stain of cerebrospinal fluid (CSF) showing bacteria, CSF protein > or =80 mg/dL, peripheral absolute neutrophil count > or =10 000 cells/mm3, seizure before or at time of presentation, and CSF absolute neutrophil count > or =1000 cells/mm3. A Bacterial Meningitis Score (BMS) was developed on the derivation set by attributing 2 points for a positive Gram stain and 1 point for each of the other variables.

Main outcome measure: The accuracy of the BMS when applied to the validation set.

Results: A BMS of 0 accurately identified patients with aseptic meningitis without misclassifying any child with bacterial meningitis in the validation set. The negative predictive value of a score of 0 for bacterial meningitis was 100% (95% confidence interval: 97%-100%). A BMS > or =2 predicted bacterial meningitis with a sensitivity of 87% (95% confidence interval: 72%-96%).

Conclusions: The BMS accurately identifies children at low (BMS = 0) or high (BMS > or =2) risk of bacterial meningitis. Outpatient management may be considered for children in the low-risk group.

PubMed Disclaimer

Comment in

Meningitis--viral versus bacterial.
Haruda FD. Haruda FD. Pediatrics. 2003 Aug;112(2):447-8; author reply 447-8. doi: 10.1542/peds.112.2.447. Pediatrics. 2003. PMID: 12897308 No abstract available.

Cited by

A diagnostic decision rule for management of children with meningeal signs.
Oostenbrink R, Moons KG, Derksen-Lubsen AG, Grobbee DE, Moll HA. Oostenbrink R, et al. Eur J Epidemiol. 2004;19(2):109-16. doi: 10.1023/b:ejep.0000017828.13995.76. Eur J Epidemiol. 2004. PMID: 15074565
Cerebrospinal fluid pleocytosis in infectious and noninfectious central nervous system disease: A retrospective cohort study.
Baunbæk Egelund G, Ertner G, Langholz Kristensen K, Vestergaard Jensen A, Benfield TL, Brandt CT. Baunbæk Egelund G, et al. Medicine (Baltimore). 2017 May;96(18):e6686. doi: 10.1097/MD.0000000000006686. Medicine (Baltimore). 2017. PMID: 28471963 Free PMC article.
The usefulness of serum delta neutrophil index for differentiating bacterial and viral meningitis in the emergency department.
Lee JW, Park CI, Kim HI, Kim OH, Cha KC, Kim H, Lee KH, Hwang SO, Cha YS. Lee JW, et al. Clin Exp Emerg Med. 2016 Jun 30;3(2):95-99. doi: 10.15441/ceem.15.095. eCollection 2016 Jun. Clin Exp Emerg Med. 2016. PMID: 27752624 Free PMC article.
Cerebro spinal fluid analysis in childhood bacterial meningitis.
Thomas V; Ahmed R; Qasim S. Thomas V, et al. Oman Med J. 2008 Jan;23(1):32-3. Oman Med J. 2008. PMID: 22567207 Free PMC article.
Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: A cross-sectional study.
Sanaei Dashti A, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Sanaei Dashti A, et al. Medicine (Baltimore). 2017 Sep;96(35):e7637. doi: 10.1097/MD.0000000000007637. Medicine (Baltimore). 2017. PMID: 28858084 Free PMC article.

Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era - PubMed